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Last Post 12/31/2007 1:26 AM by  BobH
Adjusters policing Adjusters
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Ray Hall
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11/22/2007 4:38 PM

    This topic is not discussed in public forums much, but it has been going on as long as I have been in the profession.

    Workers Comp. Property Adjusters, Auto physical damage and Liability claims of all types come to mind as well as NFIP losses.

    NFIP watchs for trends by certain adjusters and send a few  adjusters to Federal prison over the lifetime of the program. In 2003 Texas Windstorm Insurance Association, hired an adjuster to check on some of their dedicated adjusters closed files. The summary of the rechecked closed losses were the adjusters were taking photographs of the most graphic damage and not photographing the entire loss from a distance to give the examiner a true picture of the overall loss. This was actually cheating to depict the damage as great  as possible with the close up photos which resulted in over scoping ,higher payouts and higher service bills for the adjuster.

    The post on camera's brought this to mind. If you intend to stay in this profession for a long time let your photo's prove your inspection and scope was accurate and you have nothing to hide.

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    cowboy26995
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    11/23/2007 3:21 PM
    Paying adjusters a % of the loss is unfortunately an incentive for inexperienced dishonest adjusters . Padding estimates, inaccurate photos, fake photos, inflated content lists are all too abundant. The three day wonders seem to think of adjusting as a cash cow rather than an honorable profession. Proper training and supervision are needed to insure fairplay. You can't field a warm body and expect the same results as from a well trained adjuster.
    Marc Dubois
    Executive General Adjuster
    M.G.D. Claim Services Inc.
    "Your Commercial Claims Solution"
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    Tom Toll
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    11/23/2007 4:34 PM

    Ray, I have always professed that you cannot take enough photos on a loss to depict the damage you are writing. You don't have to send them all, but keep them if some question comes up. A photo tells all, if taken properly. Learn to use your camera as a tool to assist you. I have always taken twice as many photos as I need and keep the surplus in a folder in the event a question comes up. I am sorry that I am having to use MSB's photo system, as after having used Photoadjuster sofware, MSB just purely sucks. Photoadjuster tells the viewer what type of camera was used, the date and time taken, and if someone attempted to alter the photo. In other words, you could not modify a photo or tell an untruth about when it was taken. I sorely miss using that program.

    Marc, I agree with wholeheartedly. More supervision needs to occur with the newby adjuster. Many, or I should say, most newbies want to do what is ethical and right, but there are always those derelects that damage our profession. That is a vendor problem that should be resolved with good competent adjusters and file reviewers.

    Success is not final, failure is not fatal: it is the courage to continue that counts.
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    Ray Hall
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    11/23/2007 4:53 PM

    Some very basic things will expose the bad apples. Require all risk photos to have the date on the print. Require a roof shot to show a hip or a ridge of a roof in the photo, with the adjusters vehicle in the background. Require angle shots of the front elevation to show two sides or at least part of the side. Any close up/short shot to be backed up by a long shot. Require a  28mm to 105mm camera. Require a photo of all serial numbers on total losses.

    Reguire catastrophe adjusters to have a  copy  signed by the by the insured on "discussed and agreed estimates". About 85% of all insureds have high speed internet service, require this paper trail be sent in with scanned info. back and forth.

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    brighton
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    11/23/2007 9:17 PM
    Tom and Marc,

    Let's not jump on the newbies too much. Granted, some have thought of this as the cash cow supreme. The vast majority want to do things the correct way and do need guidence. How about saying the files need to be better monitored all the way around? We all know of very experienced adjusters who work the system to their benefit, just haven't gotten caught yet. They are ones who need to be watched for also.

    Since the billing increases as the loss size increases, we can be looked at by the carriers as writing more than is needed for a bigger payout. Sadly, when this is proven to be true by the acts of a bad apple, the deed affects all of us. Ray has some good points as does Tom in having the documentation to support what you write.

    I feel that with the amount of re-insurance being bought by carriers today, more and more reinspections will be made to justify to the re-insurers that what has been paid out is justified. Look at Citizens FL and you will see that they are requiring the vendors to designate people for re-inspectors during the cat operation.
    Rocke Baker
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    stormcrow
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    11/23/2007 10:55 PM

    "The vast majority want to do things the correct way and do need guidence."  This simply wasn't true in 04 and 05. Now we all are paying the price.

     

    I want to die peacefully in my sleep like my grandfather, not screaming in terror like his passengers.
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    LENNY
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    11/24/2007 12:03 PM
    When I started in this profession 12 years ago, two veteran adjuster’s who were working for one of the largest and most prestigious IA companies in our industry decided to take me under their wing and teach me the trade. One evening while discussing roof damage or the lack there of, one of the adjuster’s showed me a portfolio of photographs he had collected over time with every type of roof shingle and colors. He explained when he was unable to find enough damage on a roof he would build his file up by inserting manufactured photos increasing his fee. I was completely dumfounded and extremely disappointed as I had developed a great deal of respect for them.

    I explained to them I was very happy with the amount of money I was making (which at the time was less than they were making) I could not risk falsifying a claim jeopardizing the amount of income I could make over the long term. Needless to say this put a strain on our relationship and I proceeded to learn this profession on my own through the school of hard knocks.

    The adjuster with the portfolio of photographs shortly there after was no longer working for that company for reasons I’m not aware of and the other is no longer in this business by his own choice.

    The point is fraudulent adjusting practices are not being committed predominately by newbie adjuster’s; I believe there are more seasoned adjuster performing this practice. Once the seasoned adjuster has developed a level of trust with the submittal of good files to the examiners, thus allowing him or her to submit fraudulent claims with out shedding much light on them.

    Just my opinion.
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    Ray Hall
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    11/24/2007 1:25 PM

    The Texas wind pool is worked by established  IA firms on the Texas coast with excellant reputations, who supply the dedicated adjusters. Why was the random audit of all the vendors files made ?. Most of the fraud by adjusters is with staff or  IA's with a lot of authority and trust. The largest vendors in the business did not condon the actions of their most trusted heavy hitters during the Northridge earthquake, and paid dearly.

    The re-insurance carriers are allways looking for trends by certain adjusters. All of the large vendors give the name and SS# of each adjuster to the carriers at the end of the year for use the following year. It's not original but;" you are only as good as your last storm". 

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    Tom Toll
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    11/24/2007 3:39 PM

    Rocke, I by no means am criticizing the newbies who want to do what is right. I have always been for newbies coming in to this business, and always will. Fresh blood is always needed in any profession. What happened in 04 and 05 was a full scale screw up. People were asked to go to a 3 day training and come out as adjusters, with little or no supervision. We met a couple at the RV park we were in , in Lousiana, with a new Ford F-350, a new large motor home and they had been promised that they would have plenty of work to pay for all this. I won't mention the vendors name, but that was as reckless of a statement that I had ever heard. I understand that couple did not make it and lost everything.

    I am in hopes something was learned by all the 04/05 mess. Everything was confusing, nobody getting the information they needed, very little supervision, assigning losses scattered all over the country instead of zip coding the losses. Then comes the attorney's and their cronies. What a mess. The industry has learned some lessons, but they seem to want to throw the blame at the adjusters, and not accept the role they played with this. Nobody seems to want to accept the responsibilites for their own actions and that includes all entities that were involved in Katrina especially. I talked to a staff adjuster with FIG at the Callie fires and he said they would never use IA's again, due to our screw ups in Katirina. I told him, you have got to be kidding. I felt it was the companies fault by not supervising the losses properly and that the blame rested with them also. Start the blame game and you have no winners and certainly no way to address the short falls of the event.  We all need to address who we are and what we wish to become and this needs to be done now, not down the road.

    If you wish to become a top gun adjuster, get off you butts and start to learn what you need to learn to become one, now, not later. I don't see the necessity to use smooth words for this. Learn or get out, as you who do not wish to learn just damage the ones who do.

    Success is not final, failure is not fatal: it is the courage to continue that counts.
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    moco
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    11/24/2007 7:23 PM

    Hi Tom, i am a new adjuster. I learned from a friend who got started in '05  . He took me in and taught me everything he knew at the time, which was only approximately 1 year and some few days more experience than i had. I would do ride alongs with him about 3 -4 days a week and he paid me a day rate, not much, but where else could i have learned the basics of this trade and been paid . Now i am likely only a third, or at best half the adjuster that most of you guys here are, and that is why i am here, to  listen and learn more. Me or the guy who trained me truly do not know why we do some of the things we are instructed to do, only that this is the way things are and is what the carrier wants. As newbies we know the basic exclusions, policy coverage and etc, however we only work for 2 different carriers on average, but what we have learned has been mostly the result of trial and error, and remembering these things the next time they are encountered. I can truly say that as a newbie it is a slow and time involved learning process with this trade, with no true set of industry standards which makes things even more confusing at times. Is it that one day after doing this a while one wakes up and it is like all of the sudden you understand why everything is done the way it is, and what the carriers intent is with certain request. I am truly curious. My IA file examiner is a young girl who is not the best at explaining things, however as i stated before i have learned what not to do by making notes of her and the carrier's examiners request, its just that i do not allways know why these request are wanted. I intend on being fair and paying only for covered damages, however i do this with the little knowledge and understanding of the policies. For the most part i could not be dishonest if i wanted to because it would be caught if i did. It would seem that all vendors would watch the newbies closer and lead them in the right way.

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    okclarryd
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    11/26/2007 8:10 PM
    Me or the guy who trained me truly do not know why we do some of the things we are instructed to do, only that this is the way things are and is what the carrier wants



    GW,

    This sentence just jumped off the page. If you do what the carrier wants and expects, and do it with courtesy, knowledge, and honesty, you'll do just fine.

    Never compromise your scruples, never quit learning, and never confess to your wife.

    Happy Trails
    Larry D Hardin
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    moco
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    11/26/2007 10:17 PM

    Thanks Larry, i always have been the type to do what is wanted by the "boss". However i am one of these people that like to get in depth with things and have a complete understanding of why, when, why, how, what and so on, now hopefully this want come to bite me one day, but i just feel that a complete understanding of things is beneficial to me and will hopefully one day make the job easier and quicker. I am still so new that i will generally complete a cut and dry final report in 1-1.5 hours, but spend an additional 45 minutes disecting line by line to insure that i have not missed or left any thing out. While doing the lookover i often find myself questioning quite a lot of what has been excluded, what is being allowed for and simply "attempting to tap into the carriers mind" if you will. As i have stated, i have been trained, and learned from alot of trial and error, i know what is acceptable and what is not acceptable per the carrier i work for, but it is frustrating to me personally to not see the whole picture.Again i just feel this would give me a more in depth understanding, and essentially make the overall job easier and improve turnover time as i would understand the "whole picture". This may be a bad trait on my part but i have always been the guy who is overlly observant and want's to take a peek on the inside.

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    jsindallas
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    11/29/2007 11:20 AM
    I've seen alot of inflated estimates by newbies due to improper training on how to measure properly. They just increase the measurements in order to curb the supplements and re-opens. Until 3 day adjuster licensing is addressed, the industry will continue to suffer from in-experience flooding into disaster areas in hopes of big bucks. On the bright side this is a great source of income for the seasoned adjuster handling the re-opens after a CAT.
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    Wes
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    11/29/2007 10:05 PM
    GW, I have a little experience under my belt but still just like you I read and re-read my final report before I hit that send button off to the carrier. I am very particular about if my reports only make sense to me or if anyone who reads them will be able to understand what I am trying to get across. I am also very concerned about spelling even though we always see the argument from some adjusters about why does spelling matter if my coverage report is correct. I am extremely careful while creating my reports but I would guesstimate 50% of the time while reading my final report I will find a mistake or something I want to rewrite for clarity. I have learned never to trust spell checker as it has a sneaky little habit of correcting your spellings to words you never even heard of but it must be used on every report and then double checked for correctness. I once had an examiner come and visit me at my home office for training purposes and he questioned my wasted time spent reviewing my reports before submittal. I don't consider it wasted at all and believe it is one of the reasons I have remained a busy employed IA during these slow times.
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    rbryanhines
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    11/29/2007 11:18 PM
    Wes
    There is never a negative to reviewing reports keep it up. Remember examiners make mistakes too. During hurricane fran I had a buddy submit a file and a line on the contents worksheet stated Tugboat - little tykes- purchased from walmart and then the amount. The file was kicked back and the ilog said "commercial boats not covered". Boy did we have fun with that one!
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    Spudder
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    12/29/2007 8:13 AM

    I have been doing desk adjusting for several contractors, The biggest complaint that I have is that many of the so call adjusters may have a license but do not have proper training in the construction field, I'm doing a adjusters estimate right now and he references one of Xactimate current price lists, when I pull up that price list I see where the adjuster has changed all of the prices pertaining to the claim, he just puts in a price usually lower that the price list states, Is this an ethical function ? I have checked for base services charges part of the estimate was defaulted to using Base service charges, part of it wasn't , I have a feeling that this maybe a new person and give him or her the opportunity to explain themselves. I will call him tomorrow and find out, then depending on his/hers answers, I will proceed to the State Licensing Board and have the insured file  a complaint. Can anyone give me an answer to this price changing without verification. I hate to be a hard Donkey, but problems like this cause litigation and God knows we don't need any more of it.

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    BobH
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    12/29/2007 11:31 AM
    I have checked for base services charges part of the estimate was defaulted to using Base service charges, part of it wasn't

    BSC's can be "factored in" or "broken out". Many Ins Co's like to have them factored in. Read the Xactimate help info on BSC's and search this forum, there was a thread that clarified BSC's.   If Xactimate is set up to "break out" BSC's, and you leave all the default settings, you will get garbage because a computer cannot "think".  I just got an estimate from a contractor that had 4 BSC's, there were 2 for cleaning (one cleaning, one was a water remediation cleaner, but it's the same Emg Service crew that responded) and BSC for finish carpentry and for cabinet (toe-kick repair) but it was the same crew.  You have to use common sense.  If you DON'T use BSC's, and it is a really small job, no one is going to get out off bed to change 8' of baseboard. 

    One alternative is to use Min Charge for a small job - but you do not use Min Charge with BSC, that is double dipping.  If you want to learn more, look at several Min Chg entries in Xactimate such as cabinet Min, Finish carpentry Min, etc, and ht F-8 and read the description, and that Min Chg is to be used when BSC's are "factored in". (with that scenario, no BSC's would appear at the end of the estimate).

    That whole topic is not clear to lots of people, it gets into the concept of "economy of scale" (size of project) and helps pay for trip charges for a trade when it is a small job.  but the program may spit out overlapping BSC's if you have the right combo of repair items.  And if the person at the computer doesn't fully understand this topic, and has the computer set to "break out" BSC's, it will add 2 or 3 labor hours BSC for a roofer even if you are writing an estimate to do a HUGE roof project.

    Sometimes people that don't understand the Xactimate BSC's will not make a decision to learn - and don't know that they need to be either "factored in " or "broken out".  So they leave the default setting "Broken out" but delete all of them.  that is an error.  If they don't want the BSC they should set up the "properties" of the estimate to "factor in" BSC's and the unit costs will increase slightly.  But if you are only changing 8 feet of baseboard, the slight increase in unit cost is not going to allow for the trip charges... you get the idea.  With a larger project the factored-in method is recommended by Xactimate.

    So - at the end of the day - you are not going to find someone at a license board who will agree that someone did something wrong with BSC's.  Don't expect them to know what a BSC is.  Most people in this industry don't fully understand them, so you go outside that envelope and the air gets thin. 

    The spirit of BSC's is that they are a tool, and it needs to be understood.  There is nothing wrong with deleting duplicate BSC's, or overlapping BSC's.  A green adjuster may look at a small bathroom repair, and put in Min Chge for paint, for drywall, for finish carpentry, and flooring.  Yet any seasoned examiner will not want to see more than 1 or 2 minimums as it becomes a scenario like driving to 4 constructions sites - but it is the same small bathroom.  This is adjusting 101.
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    If you are looking at estimates written in the past, what price list are you comparing them to? Today's price list? Maybe you see the "*" that shows an item has been modified.

    As far as ethics, it cuts both ways. I know from your other posts you are not currently an insurance adjuster - so the term "adjusting" for contractors is sort of out of context for us. We use the word "adjust" to mean we are settling claims on the Insurance side, and I believe you are on the contractor, possibly PA side, which is fine.

    My point is that contractors and PA's can also tweak unit costs. (increase them).  Sometimes it is warranted.   In a perfect world they make a little note to explain why.  Sometimes they just raise the price and call it good.  I personally have not seen any adjuster LOWER a price from the database they have to work with. Why would they??? It isn't going to help them get the claims settled, closed, and off their desk. If it's an independent adjuster, his paycheck is lowered if the claim is lowered. Of course if he does bad work and over-pays he can' t keep that up forever, so we try to just do what's right.

    Focus on doing what's right for the customer - filing complaints and spanking people with the bureaucracy of Licensing Boards etc. is not going to help your customer or do anything other than create an enemy. It is a small world as someone posted recently. I just met a contractor who was my Insured 12 years ago, and at that time he was an adjuster for GAB (but he had a fire at his own house).   Now he's a contractor on a new file I am assigned, with coverage issues.  The contractor knew it wasn't covered (surface water) as he was a seasoned Insurance Adjuster in the past.

    Who is the claims examiner on my file? A woman who used to work alongside this same adjuster when they were at Cunningham-Lindsey years ago. We all knew each other - and commenting on what a small world it is (6 billion people, but not in the claims world).  Now I learn that this adjuster-turned contractor will do mold remediation without demanding a Pre-test, and I have 2 carriers who won't pay for pre-test, only the final clearance test for mold. The other vendors in my area demand pre-test and protocol from hygienist, to lower their liability.

    What if I had "turned this adjuster in" for some perceived mistake 12 years ago? It is like using the bathroom in a fishbowl. You gotta swim in it, so try to be nice to people until it is clear that they are an absolute enemy. Then you fight to the death - don't do anything 1/2 way. If we are nice, we try to be 100% professional and a nice guy - no matter how bad of a day the customer is having, or you are having. That is a normal day, not turning people in to the authorities.

    Bob H
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    Spudder
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    12/29/2007 1:21 PM

    Bob I was not concerned about the Base Service charges I just pointed out the estimate that I have has certain items that were estimated using a base service charge when the total of that item would not justify the BSC, my concern was the changing of Xactimate prices on the price list and stating that the price list was authentic. I just want to know why they change the current price list to satisfy a claim. My Daughter is a PA and my one son is a IA, I just check out the clients estimates and file for supplements, My kids want me to get my 5-20, but since my accident I can't get around much any more. The price list was current and except for the deductions, was in order. What I 'm saying is that the adjuster should have put a disclaimer on his estimate. I personally do not think that it is ethical for the adjuster to say this is Xactimate's price and the insured accept his actions. The State of Florida loves to investigation especially when it comes to adjusters and contractors lol I just hate to see the insured take a hit for 5,000. BTW when I review the estimates I also point out when an adjuster makes a mistake by under charging, if he insurer is not entitled to the freebie then he shouldn't get it, Some where someone told me the insured are not supposed to make a profit on the claim.

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    BobH
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    12/29/2007 1:42 PM
    Gotcha. Let us know if you find that the adjuster LOWERED a price from the database. That would be the first I have heard of that.

    What is the repair item? Something common like roofing, flooring, paint, drywall?

    Maybe it is a specific thing like an AC condensor unit, with a local price quote. This is a good example of why an estimate should "stand on it's own" and include explanations for WHY something is unique. I just did one on a living room that had a huge salt-water fish tank. If I didn't mention it, someone reading the estimate would think I was giving away the store with content manipulation.

    Let us know if you find out what happened. I think the more common problem is people overlooking scope items, as they don't know the door casings have to come off to do that drywall repair, as they have never done that kind of work themselves, and that is an honest mistake out of ignorance. What you are talking about is different, a knowing lowering of a price. Let us know.
    Bob H
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    OdieWyatt
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    12/29/2007 10:42 PM
    I think price changing depends on the situation. On a large job if some are high and some are low, just leave them alone and they should equal out. For a smaller or a specific trade job, such as roofing, I don't think there is anything wrong with changing the price, up or down, to meet the market. Instead of picking one of the 4 choices available in Xactimate for a 20 yr 3 tab shingle, that is, an installed price of 118.87 (BSC FI) or 122.31 (BSC FI + 8.25 mat tax) or 107.21 (BSC FO) or 110.65 (BSC FO + 8.25 mat tax) for a 20 year 3 tab roof, I think it is better to change the price to what the local roofers are charging, 112.00 (which includes tax, felt, metal edge and plumbing jacks).

    Xactimate is just a tool, to estimate a repair, it is not an agreed price database written into the insurance policy provisions.
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